Exercise and Physical Therapy Interventions for Children with Ataxia: A Systematic Review

Abstract

The effectiveness of exercise and physical therapy for children with ataxia is poorly understood. The aim of this systematic review was to critically evaluate the range, scope and methodological quality of studies investigating the effectiveness of exercise and physical therapy interventions for children with ataxia. The following databases were searched: AMED, CENTRAL, CDSR, CINAHL, ClinicalTrials.gov, EMBASE, Ovid MEDLINE, PEDro and Web of Science. No limits were placed on language, type of study or year of publication. Two reviewers independently determined whether the studies met the inclusion criteria, extracted all relevant outcomes, and conducted methodological quality assessments. A total of 1988 studies were identified, and 124 full texts were screened. Twenty studies were included in the review. A total of 40 children (aged 5–18 years) with ataxia as a primary impairment participated in the included studies. Data were able to be extracted from eleven studies with a total of 21 children (aged 5–18 years), with a range of cerebellar pathology. The studies reported promising results but were of low methodological quality (no RCTs), used small sample sizes and were heterogeneous in terms of interventions, participants and outcomes. No firm conclusions can be made about the effectiveness of exercise and physical therapy for children with ataxia. There is a need for further high-quality child-centred research.Electronic supplementary materialThe online version of this article (10.1007/s12311-019-01063-z) contains supplementary material, which is available to authorized users.

Results From the WAGR Syndrome Patient Registry: Characterization of WAGR Spectrum and Recommendations for Care Management

“…Standard prevention and treatment for obesity and metabolic syndrome include a healthy diet/caloric intake and exercise, although several factors associated with WAGR syndrome can present challenges to these standard therapies, supporting the need for a multidisciplinary care team approach. Approximately a quarter of participants in the WAGR Discovery Cohort reported ataxia, which can lead to a variety of functional difficulties that complicate normal exercise, such as balance and walking issues and a recent systematic review found that evidence is lacking related to the effectiveness of physical therapy and exercise interventions for children with ataxia ( 52 ). Additionally, a substantial portion of participants reported issues with hypo- or hypertonia, toe-walking, spasticity, and scoliosis which highlights the need for neurological and orthopedic evaluations to determine whether any issues are present that could affect the ability to exercise.…”

Cutaneous and muscular afferents from the foot and sensory fusion processing: Physiology and pathology in neuropathies

“…231 However, treatment should depend on the disease and the impairments. For instance, it is not clear whether exercise can be helpful in children with ataxia, 275 and strengthening exercises may not be manifestly effective in adult patients with Charcot-Marie-Tooth disease, 276 whereas adapted training can be helpful. 277 Endurance and balance training seem to be effective in chemotherapyinduced peripheral neuropathies.…”

Update on the Treatment of Ataxia: Medication and Emerging Therapies

“…Physical therapy, home exercise programs (including stretching, core strengthening, balance, and cardio), occupational therapy, speech and swallowing therapy, weighted vests [8], orthotics, assistive equipment assessment, home safety evaluations, and driving evaluations can all improve patient and family quality of life and safety, reduce falls, and help maintain patient independence [9,10]. Home Health organizations can provide these resources, as well as nursing and social work assistance, for the homebound.…”